Minimum Competency Recommendations for Programs That Provide Rehabilitation Services for Persons with Disorders of Consciousness

Date of Recording: October 2020

Persons who have disorders of consciousness (DoC) require care from multidisciplinary teams with specialized training and expertise in management of the complex needs of this clinical population. The recent promulgation of practice guidelines for patients with prolonged DoC by the American Academy of Neurology; American Congress of Rehabilitation Medicine (ACRM); and National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) represents a major advance in the development of care standards in this area of brain injury rehabilitation. Implementation of these practice guidelines requires explication of the minimum competencies of clinical programs providing services to persons who have DoC. The Brain Injury Interdisciplinary Special Interest Group of ACRM, in collaboration with the DoC Special Interest Group of NIDILRR-Traumatic Brain Injury Model Systems, convened a multidisciplinary panel of experts to address this need through the present position statement. Content area-specific workgroups reviewed relevant peer-reviewed literature and drafted recommendations, which were then evaluated by the expert panel using a modified Delphi voting process. The process yielded 21 recommendations on the structure and process of essential services required for effective DoC-focused rehabilitation, organized into four categories: diagnostic and prognostic assessment (four recommendations), treatment (11 recommendations), transitioning care/long-term care needs (five recommendations), and management of ethical issues (one recommendation). Two of the senior authors of the position statement will present the seminar by emphasizing the infrastructure requirements and operating procedures for the provision of DoC-focused neurorehabilitation services across subacute and postacute settings.

Learning Objectives: 

• List the four content areas targeted as minimal standards in DoC rehabilitation programs. 
• Describe the role of neurobehavioral assessment in DoC rehabilitation programs.
• List treatment targets in DoC rehabilitation programs.
• Describe care transition standards in DoC rehabilitation.
• List the kinds of policies that should be implemented in dealing with ethical issues in DoC rehabilitation.

Presenter Information: 

Risa Nakase-Richardson, PhD, FACRM is a clinical research neuropsychologist at the James A. Haley Veterans’ Hospital and professor and research director in the Morsani College of Medicine Pulmonary, Critical Care and Sleep Medicine, at the University of South Florida. She has worked in neurorehabilitation in both clinical and research capacities since 1998. She is a Fellow of the American Congress of Rehabilitation Medicine and National Academy of Neuropsychology. She has over 100 publications and over 200 presentations at scientific meetings. She has served as principal investigator or investigator on 19 grants funded by various federal agencies and private organizations, including the Department of Veterans Affairs; United States Department of Defense; Patient-Centered Outcomes Research Institute (PCORI®); National Institutes of Health, NIDILRR; and National Action Network. She has worked at the VA Polytrauma Rehabilitation Center in Tampa, Florida, since 2008. 

John Whyte, MD, PhD, FACRM is founding director and institute scientist emeritus at Moss Rehabilitation Research Institute. He received his MD and PhD in experimental psychology from the University of Pennsylvania and completed a residency in physical medicine and rehabilitation at the University of Minnesota and a neurotrauma fellowship at Tufts University. His research has focused on severe brain injury and its cognitive sequelae, including work on natural history, assessment, long-term outcomes, and treatment. A substantial portion of his research portfolio has focused on DoC. In addition to his empirical research, he has written extensively on the special methodologic challenges posed by rehabilitation research, the specification of rehabilitation treatments, and the training of future rehabilitation researchers. His research has been supported by National Institutes of Health; NIDILRR; Patient-Centered Outcomes Research Institute (PCORI®), United States Department of Defense, and several private foundations. He has served in leadership positions within the Association of Academic Physiatrists and the American Congress of Rehabilitation Medicine and in 2005 he was elected to the National Academy of Medicine.